The Young Hearts for Life®(YH4L) Cardiac Screening Program, nationally known for its unique model, has screened over 180,000 students for conditions associated with sudden cardiac death. This milestone is a first for any heart screening program of this kind in the United States. Each week, sudden cardiac death claims the lives of more than 60 young adults in the United States. YH4L has been a leader the medical community to address this problem in the Chicago area. Because of our generous donors and sponsors, we have been able to offer this screening to your child for FREE. Please consider supporting this program so we can continue to offer this to students in our area.

For more information about the YH4L program and what we offer, please visit our website at YH4L.org.

Register

Dear Parents/Guardians,

We are pleased to bring the Young Hearts for Life® (YH4L) Cardiac Screening Program to your student's high school. All students whose parents authorize them to be tested will be screened. Please be aware that repeat ECG testing is recommended every two years.

YH4L will provide this free heart screening called an electrocardiogram (ECG) to identify high school students at risk for sudden cardiac death and to increase the public's awareness of this issue. To date over 180,000 students have been screened as a result of YH4L. More information about the screening can be found here.

A simple ECG, when used to screen young adults can detect certain
serious heart conditions. Recording the electrical activity of the heart using electrodes
attached to the skin with a mild adhesive, can detect approximately 60% of the abnormalities
or “markers” from these heart conditions that are associated with sudden cardiac
death that a stethoscope cannot. ECG screenings result in less than 2% of the tests being falsely positive.
This may require additional evaluation and testing by your physician. We believe that the
benefit of this potentially life saving screening outweighs this concern.

We encourage you to discuss this screening with your child. Your child’s participation
in the screening is your decision. We want to assure you that students’ confidentiality,
privacy and individual modesty will be respected throughout all aspects of the program.
Only female technicians will test girls and they will be screened in an area separate
from boys.

Current Testing Dates Listed Below:

Reavis High School
on
09/05/2019 - 09/05/2019

Downers Grove South High School
on
09/12/2019 - 09/12/2019

William Fremd High School
on
09/26/2019 - 09/26/2019

St. Laurence High School
on
10/03/2019 - 10/03/2019

Schaumburg High School
on
10/17/2019 - 10/17/2019

Oswego East High School
on
10/24/2019 - 10/24/2019

Lyons Township High School (SOUTH CAMPUS)
on
11/07/2019 - 11/07/2019

Lyons Township High School (NORTH CAMPUS)
on
11/14/2019 - 11/14/2019

Aurora Christian High School
on
11/21/2019 - 11/21/2019

St. Charles East High School
on
11/21/2019 - 11/21/2019

East Aurora High School
on
12/05/2019 - 12/05/2019

Plainfield Central High School
on
12/12/2019 - 12/12/2019

Bolingbrook High School
on
01/09/2020 - 01/09/2020

Plainfield East High School
on
01/16/2020 - 01/16/2020

Montini Catholic High School
on
01/23/2020 - 01/23/2020

Geneva Community
on
02/06/2020 - 02/06/2020

Addison Trail High School
on
02/20/2020 - 02/20/2020

Downers Grove North High School
on
02/27/2020 - 02/27/2020

Naperville North High School
on
03/12/2020 - 03/12/2020

Oak Lawn Community High School
on
03/19/2020 - 03/19/2020

Lemont High School
on
03/26/2020 - 03/26/2020

Barrington High School
on
04/02/2020 - 04/02/2020

Willowbrook High School
on
04/23/2020 - 04/23/2020

Naperville Central High School
on
04/30/2020 - 04/30/2020

Streamwood High School
on
05/07/2020 - 05/07/2020

Glenbard East
on
05/14/2020 - 05/14/2020

I give permission for my child to participate in the Young Hearts for Life® Cardiac
Screening in which my child will receive an electrocardiogram. An electrocardiogram (also known as EKG or ECG) is a non-invasive
test that measures the electrical activity of the heart and can detect certain heart
abnormalities that may lead to sudden cardiac death.

I understand that my child’s participation in the Young Hearts for Life® Cardiac
Screening is intended to identify heart abnormalities which may affect their health
during physical activities. I assume all risks associated with my child’s participation
in the Cardiac Screening. All such risks being known and appreciated by me and having
read this waiver I hereby for myself, heirs, executors, and administrators waive
any and all claims I may have for damages against Young Hearts for Life and any and all individuals associated with this screening, their
heirs, representatives and successors, and assignees for any and all injuries suffered
by my child in connection with this screening or any actions or omissions related to the screening even though that liability may arise
out of negligence or carelessness on the part of those named in this waiver.

I understand that Young Hearts for Life® will endeavor to keep my child’s health information confidential
pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)
and its related Rules and Regulations and other state laws. I understand that my student’s
results may be used, after being de-identified, for research purposes. In the event my child’s
ECG result indicates that further evaluation is needed, Young Hearts for Life
may contact me for additional information.

I grant permission to all the foregoing to use any photographs, recordings or any
other record of this event for any legitimate purpose consistent with HIPAA and
its related Rules and Regulations and other state laws.
Yes

I acknowledge that I have read this Permission Form and Waiver
and understand the risks associated with my child’s participation in the Young Hearts
for Life® Cardiac Screening.